Provider Demographics
NPI:1588874945
Name:OLSON, JOY ILYNN (LMT)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:ILYNN
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2230 NW PETTYGROVE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2659
Mailing Address - Country:US
Mailing Address - Phone:503-224-4804
Mailing Address - Fax:503-224-7391
Practice Address - Street 1:2230 NW PETTYGROVE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2659
Practice Address - Country:US
Practice Address - Phone:503-224-4804
Practice Address - Fax:503-224-7391
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#3202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist